Impact of donor-recipient age on cardiac transplant survival. Subanalysis of the Spanish Heart Transplant Registry
Raquel López-Vilella 1 , Francisco González-Vílchez 2 , María G Crespo-Leiro 3 , Javier Segovia-Cubero 4 , Manuel Cobo 2 , Juan Delgado-Jiménez 5 , José María Arizón Del Prado 6 , Manuel Martínez-Sellés 7 , José Manuel Sobrino Márquez 8 , Sonia Mirabet-Pérez 9 , José González-Costello 10 , Félix Pérez-Villa 11 , José Luis Lambert-Rodríguez 12 , Gregorio Rábago-Aracil 13 , María Teresa Blasco-Peiró 14 , Luis de la Fuente-Galán 15 , Iris Garrido-Bravo 16 , Déborah Otero 17 , Luis Almenar-Bonet 18
Introduction and objectives: The age of heart transplant recipients and donors is progressively increasing. It is likely that not all donor-recipient age combinations have the same impact on mortality. The objective of this work was to compare survival in transplant recipients according to donor-recipient age combinations.
Methods: We performed a retrospective analysis of transplants performed between 1 January 1993 and 31 December 2017 in the Spanish Heart Transplant Registry. Pediatric transplants, retransplants and combined transplants were excluded (6505 transplants included). Four groups were considered: a) donor <50 years for recipient <65 years; b) donor <50 years for recipient ≥ 65 years; c) donor ≥ 50 years for recipient ≥ 65 years, and d) donor ≥ 50 years for recipient <65 years.
Results: The most frequent group was young donor for young recipient (73%). There were differences in the median survival between the groups (P <.001): a) younger-younger: 12.1 years, 95%CI, 11.5-12.6; b) younger-older: 9.1 years, 95%CI, 8.0-10.5; c) older-older: 7.5 years, 95%CI, 2.8-11.0; d) older-younger: 10.5 years, 95%CI, 9.6-12.1. On multivariate analysis, independent predictors of mortality were the age of the donor and the recipient (0.008 and 0.001, respectively). The worst combinations were older-older vs younger-younger (HR, 1.57; 95%CI, 1.22-2.01; P <.001) and younger-older vs younger-younger (HR, 1.33; 95%CI, 1.12-1.58; P=.001).
Conclusions: Age (of the donor and recipient) is a relevant prognostic factor in heart transplant. The donor-recipient age combination has prognostic implications that should be identified when accepting an organ for transplant.